Many teens try
alcohol, tobacco, or drugs. Some teens try these substances only a few times and stop. Others can't control
their urges or cravings for them. This is substance abuse.
may try a number of substances, including cigarettes, alcohol, household
chemicals (inhalants), prescription and
over-the-counter medicines, and illegal drugs.
Teens use alcohol more than any other substance. Marijuana is the illegal drug that teens use most often.
Teens may use
a substance for many reasons. They may do it because:
Teens tend to try new things and take risks, so
they may take drugs or drink alcohol because it seems exciting.
Teens with family members who have problems with alcohol or other drugs are
more likely to have serious substance abuse problems. Also, teens who feel that
they are not connected to or valued by their parents are at greater risk. Teens
with poor self-esteem or emotional or mental health problems, such as
depression, also are at increased risk.
Substance abuse can lead to serious problems such as poor schoolwork,
loss of friends, problems at home, and lasting legal problems. Alcohol and drug
abuse is a leading cause of teen death or injury related to car crashes,
suicides, violence, and drowning. Substance abuse can increase the risk of
sexually transmitted infections (STIs), including
HIV, because of unprotected sex. Even occasional alcohol use by a teen increases the risk for future alcohol and drug problems.
casual use of certain drugs can cause severe health problems, such as an
overdose or brain damage. Many illegal drugs today are made in home labs, so
they can vary greatly in strength. These drugs also may contain bacteria,
dangerous chemicals, and other unsafe substances.
important to be aware of the signs that your teen may be abusing alcohol,
drugs, or other substances. Some of the signs include:
If your teen is using alcohol,
tobacco, or drugs, take it seriously. One of the most important things you can
do is to talk openly with your teen about the problem. Urge him or her to do
the same. Try not to use harsh, judging words. Be as supportive as you can
during this time.
In most cases, a hostile, angry face-to-face meeting pushes
your teen away from the family. If you don't know what to do or if you feel
uncomfortable, ask for help from a
psychologist, or psychiatrist.
The type of treatment your
teen needs depends on the level of substance abuse. For example, if your teen has
tried drugs or alcohol only a few times, talking openly with him or her about the problem may
be all that you need to do. But
if your teen has a
substance abuse problem, then he or she needs to be
seen by a doctor, a counselor, or both. If your teen is addicted to a drug or
alcohol, he or she may need to have detoxification treatment or a treatment
that replaces the substance with medicine. Medicine works best if it is
combined with one-on-one or family counseling, or both.
to substance abuse, called relapse, is common after treatment. It is not a
failure on the part of your teen or the treatment program. Recovery from
addiction is hard and takes time. Know that there may be setbacks that your
teen will need to overcome one step at a time.
help prevent substance use:
Health Tools help you make wise health decisions or take action to improve your health.
Learning about teen substance abuse:
Preventing teen substance abuse:
Dealing with substance abuse:
Substance use can lead to long-term social and health problems, injury, and even death. Growth
and development can be affected by tobacco, alcohol, and drugs. Teens who abuse these substances
may have trouble finding their identity, building relationship
skills, and becoming emotionally stable. They also may have trouble preparing for their future. Substance abuse can affect memory and learning, which can
harm a teen's schoolwork.
And substance use can grow very quickly from
experimenting or occasional use to abuse and addiction
in teens at risk.
Nicotine is only one of the thousands of chemicals in tobacco, but it is the major component that acts on the brain.
The lungs readily absorb nicotine from the smoke of cigarettes, cigars, or pipes. The tissues of the mouth can also
absorb nicotine when a person smokes cigars or pipes or chews tobacco.
Nicotine is one of the most addictive substances. Some teens show early signs of addiction within days to weeks
after starting to smoke. Repeated tobacco use causes a need for increasingly larger amounts of nicotine to feel the
same effect (tolerance). And repeated use causes withdrawal symptoms if the person tries to quit.
Alcohol affects all organs of the body but has its most serious effects on the liver. Alcohol decreases the quality of sleep, especially if a person is using it often to help him or her fall asleep. It can cause problems with brain development in teens. Some teens who drink alcohol regularly may not learn how to handle stressful situations without drinking alcohol.
Alcohol is a sedative. So drinking alcohol makes it harder for a person to think and act quickly. It slows down thinking and moving, and it makes a person less alert. A car crash is more likely when a person drives after drinking alcohol.
Drinking can lead teens to have
unprotected sex. This raises the chance of pregnancy and sexually transmitted infections (STIs).
Marijuana can hinder
memory, problem-solving, and learning. It can also cause mood swings, anxiety,
Cocaine can cause
abnormal heartbeats, sometimes causing a deadly
Other substances teens abuse include:
family, and community factors increase a teen's risk for using substances and
possibly developing a problem.
Teens are more likely to use alcohol or drugs if:
Teens who don't use alcohol,
cigarettes, and other drugs are less likely to use them as adults. Efforts to
prevent teen substance abuse should begin early in life with education, encouragement of healthy behaviors, and good
self-esteem, a supportive family, and
positive role models help teens gain confidence to make good choices.
If you live in a high-risk neighborhood or your teen is at high risk for
an abuse problem, a community program can help your teen learn
skills to avoid substance abuse.
Even young school children have opinions about substance use. So start
early to help your child learn the skills needed to avoid substance use.
hard to tell if your teen is using alcohol or drugs. Parents may worry
that their teens are involved with drugs or alcohol if they become withdrawn or
negative. But these behaviors are common for teens going through
It's important not to accuse your teen unfairly. Try
to find out why your teen's behavior has changed. Tell him or her that you
Experts recommend that parents look for a pattern or a number of changes in
appearance, behavior, and attitude, not just one or two of the changes listed here.
Any use of alcohol, cigarettes,
or drugs in childhood or the teen years is a problem, unless
it turns out to be a one-time event. If you suspect or see signs that
your teen is using substances, check it out. Don't wait for it to become a
A home drug screening test provides immediate, early information about whether a
urine sample contains drugs such as amphetamine, cocaine, and marijuana. But it does not show which drug has been used, and some tests are inaccurate.
If you think that
your teen is using alcohol or drugs, gather all the information you can before
taking your teen to a health professional. This will help ensure an accurate
Health professionals who
can diagnose and treat substance abuse problems include:
Professional counseling for
addiction, either individually or in a group setting, can be done by a:
health professional believes that your teen may have a substance abuse problem, he
or she will ask about your child's
medical history and will do a
physical exam. He or she will ask
questions about your teen's attitude toward substance use, the history of use, and
any effects of drug use. The health professional will want to talk with your teen in private.
Urine, blood, or
hair drug analysis (toxicology testing) or a
blood alcohol test is not usually done to diagnose
abuse problems. Health professionals typically will not do these tests without
the teen's consent. Parental consent is not enough unless
there is a medical or legal reason for testing.
The health professional may try to find out if your teen has
attention deficit hyperactivity disorder (ADHD),
depression, long-term depressed mood (dysthymic
anxiety disorders, or
post-traumatic stress disorder. These health problems are common in teens who
abuse substances. Your child's doctor will want to treat these problems and the substance abuse.
Your doctor may refer you to a professional
who is experienced in teen alcohol and drug problems.
Ideally, when your child is in grade school, your doctor will begin asking about your child's attitudes toward alcohol, cigarettes, and drugs. As your child grows, the doctor will continue to discuss this issue during medical visits. Getting help at an early age is very important. That's because early
substance use increases the chance that your child will become dependent on alcohol or have
other risky behaviors.
A health professional who suspects that you
or another family member has a substance abuse problem will discuss treatment.
Getting treatment early for yourself (or another family member) decreases your
child's risk of having a substance abuse problem. Also, your child
will be more likely to get treatment early if he or she does develop a
substance abuse problem.
You can help find the right treatment for your teen and help him or her succeed during and after treatment.
The type of treatment your teen gets will depend on how bad his or her substance problem is.
There are several types of teen
substance abuse treatment programs.
Inpatient programs are
highly structured and closely supervised in a hospital or
treatment center. The teen stays day and night during treatment, which
normally lasts about 4 weeks. These programs usually have an aftercare program
that provides support and encouragement.
Outpatient programs range from very structured programs with psychotherapy and family therapy to
Whatever type of program you choose, it
should consider teen developmental issues, such as
peer pressure and the need to test limits. The treatment also needs to
provide a way for your teen to continue his or her education. It may boost your teen's
self-confidence and self-esteem if he or she can do even small academic
tasks during treatment.
Getting a teen to
stop using alcohol, cigarettes, or other drugs is only the first step.
Substance use fills an emotional need. That need has to be found and satisfied in
a healthy way for your teen to be able to stay off the
Returning to substance use (having a relapse) after
treatment is common. It's not considered a treatment failure. Most relapses
occur within the first 3 months after treatment. Most often, teens need to go
through treatment more than once and follow a long recovery process.
Your teen is less likely to relapse if:
Alcoholics Anonymous (AA) is a support group and self-help program
for recovery from alcohol use problems as well as other substance abuse
problems. Meetings are available in most communities at various times. Meetings
can be "open" (for the person and his or her family) or "closed" (for the
person only). Special groups for women, teens, and gay/lesbian people may be
available in some areas. AA provides written information on the program of
recovery. Phone numbers for local offices are listed in local area phone
This website is sponsored by the Nemours Foundation. It
has a wide range of information about children's health—from allergies and
diseases to normal growth and development (birth to adolescence). This website
offers separate areas for kids, teens, and parents, each providing
age-appropriate information that the child or parent can understand. You can
sign up to get weekly emails about your area of interest.
National Institute on Alcohol Abuse and Alcoholism created thecoolspot for 11- to 13-year-olds. It's meant to give preteens and
young teens a picture of alcohol use among their peers. Accurate information is
given about how much teens their age drink. And thecoolspot has information not
only to help teens learn skills to resist the pressure to drink but also to
give them reasons not to drink.
This organization provides information for the public on
drugs. It contains information about how certain drugs affect the brain.
This organization provides information on alcohol and different drugs. The Web site has personal stories and information on teen drug and alcohol use, including how drugs affect the brain and body.
The Partnership for a Drug-Free America is a nonprofit organization
whose mission is to reduce illegal drug use in the United States. The
organization provides a large range of materials on prevention and treatment
targeted to parents and teens.
Other Works Consulted
American Academy of Child and Adolescent Psychiatry
(2005). Practice parameter for the assessment and treatment of children and
adolescents with substance use disorders. Journal of the American Academy of Child and Adolescent Psychiatry, 44(6): 609–621.
American Cancer Society (2010). Child and teen tobacco use. Available online: http://www.cancer.org/Cancer/CancerCauses/TobaccoCancer/ChildandTeenTobaccoUse/index.
Bukstein OG (2009). Adolescent substance abuse. In BJ Sadock et al., eds., Kaplan and Sadock’s Comprehensive Textbook of Psychiatry, 9th ed., vol. 2, pp. 3818–3834. Philadelphia: Lippincott Williams and Wilkins.
Centers for Disease Control and Prevention (2010). Youth risk behavior surveillance—United States, 2009. MMWR, 59(SS-5): 1–142.
Johnston LD, et al. (2012). Monitoring the Future national results on adolescent drug use: Overview of key findings, 2011. Ann Arbor: Institute for Social Research, The University of Michigan. Available online: http://monitoringthefuture.org/pubs/monographs/mtf-overview2011.pdf.
Moeller FG (2011). Drug abuse and dependence. In EG Nabel, ed., ACP Medicine, section 3, chap. 6. Hamilton, ON: BC Decker.
Shonkoff JP, et al. (2012). The lifelong effects of early childhood adversity and toxic stress. American Academy of Pediatrics, 129(1): e232–e246. Available online: http://pediatrics.aappublications.org/content/129/1/e232.full.html.
Stager MM (2011). Substance abuse. In RM Kliegman et al., eds., Nelson Textbook of Pediatrics, 19th ed., pp. 671–685. Philadelphia: Saunders.
Substance Abuse and Mental Health Services Administration (2012). Results From the 2010 National Survey on Drug Use and Health: National Findings (Office of Applied Studies, NSDUH Series H-42, DHHS Publication No. SMA 11-4667). Available online: http://www.samhsa.gov/data/NSDUH/2k10MH_Findings/2k10MHResults.htm.
July 20, 2012
Patrice Burgess, MD - Family Medicine
& Peter Monti, PhD - Alcohol and Addiction
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